1918 年大流感期间家庭内的流感传播。
Influenza transmission in households during the 1918 pandemic.
机构信息
Medical Research Council Centre for Outbreak Modelling and Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St. Mary’s Campus, London W2 1PG, United Kingdom.
出版信息
Am J Epidemiol. 2011 Sep 1;174(5):505-14. doi: 10.1093/aje/kwr122. Epub 2011 Jul 11.
Analysis of historical data has strongly shaped our understanding of the epidemiology of pandemic influenza and informs analysis of current and future epidemics. Here, the authors analyzed previously unpublished documents from a large household survey of the "Spanish" H1N1 influenza pandemic, conducted in 1918, for the first time quantifying influenza transmissibility at the person-to-person level during that most lethal of pandemics. The authors estimated a low probability of person-to-person transmission relative to comparable estimates from seasonal influenza and other directly transmitted infections but similar to recent estimates from the 2009 H1N1 pandemic. The authors estimated a very low probability of asymptomatic infection, a previously unknown parameter for this pandemic, consistent with an unusually virulent virus. The authors estimated a high frequency of prior immunity that they attributed to a largely unreported influenza epidemic in the spring of 1918 (or perhaps to cross-reactive immunity). Extrapolating from this finding, the authors hypothesize that prior immunity partially protected some populations from the worst of the fall pandemic and helps explain differences in attack rates between populations. Together, these analyses demonstrate that the 1918 influenza virus, though highly virulent, was only moderately transmissible and thus in a modern context would be considered controllable.
对历史数据的分析极大地影响了我们对大流行性流感流行病学的理解,并为当前和未来的流行疫情分析提供了依据。在这里,作者首次分析了先前未发表的 1918 年“西班牙”H1N1 流感大流行的大型家庭调查文件,首次定量分析了在这场最致命的大流行中人际间流感的传染性。作者估计人际传播的可能性相对较低,与季节性流感和其他直接传播感染的可比估计值相似,但与最近对 2009 年 H1N1 大流行的估计值相似。作者估计无症状感染的可能性非常低,这是对该大流行的一个未知参数,与异常致命的病毒一致。作者估计既往免疫力很高,他们将其归因于 1918 年春季(或可能是交叉反应性免疫)的一次未报告的流感流行。根据这一发现进行推断,作者假设既往免疫力使一些人群部分免受秋季大流行的最严重影响,并有助于解释不同人群的发病率差异。这些分析共同表明,1918 年流感病毒虽然高度致命,但传播能力仅适中,因此在现代背景下被认为是可控的。